Thank you for helping your child join the Youth Leadership InItiative! We can’t wait to welcome them.

Before the program begins, we need some important information from you. Please fill out all forms below. 

Consent Form

  • Please type your full name to e-sign the statement above.

Commitment and Contribution Form

  • My child/youth is applying to participate in the Youth Leadership Initiative program for 2016 - 2017. I understand that this is a program focused on social justice, diversity, and civic engagement that runs from July 2015 to May 2016.

    I understand that, if my child/youth is selected to participate in InIt, s/he is required to attend an overnight retreat called “Immersion Week” from Monday, July 11 - Friday, July 15, 2016 at Eastern Nazarene College in Quincy, MA, as well as one Saturday program day each month from September through April and a graduation ceremony in May. In addition, InIt participants are expected to develop and complete a project during the program year through their school or host community organization.

    I understand that there is a family/student tuition fee associated with InIt’s intensive 250+ hour leadership program.

    Note: YW Boston offers tuition fees on a sliding scale based on annual household income, as detailed in the table below. In order to keep the program financially viable, InIt counts on families to contribute the highest amount they can afford. If you have any questions or would like to discuss financial options, please contact Daniela Gonzalez-Jatar at 617-585-5462. Family/student financial hardship does not preclude participation in the InIt program.

    Family/Student Contribution per Delegate

    • Annual household income less than $47,000 = $50 contribution
    • Annual household income between $47,001 and $70,000 = $200 contribution
    • Annual household income between $70,001 and $94,000 = $500 contribution
    • Annual household income more than $94,000 = $1,000 contribution

    I understand that all tuition and contributions are non-refundable. I understand that all payments must be received before my child/youth starts the program in July, unless I have requested alternative payment arrangements.

  • Please type your full name to e-sign the statement above.

Contact Information Release

  • We will distribute a program roster and contact list to all participants and staff to facilitate keeping in touch throughout the program.
  • Please type your full name to e-sign the statement above.

Photo Release

  • Please type your full name to e-sign the statement above.

Health and Medical Release

  • Basic Information

  • Date Format: MM slash DD slash YYYY
  • Separate by comma
  • Health History

  • Does the participant have any of the following medical conditions? Check all that apply.
    If yes, bring enough medication to last the entire duration of Immersion Week. Keep it in the original packaging/bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration.
  • For all medications, please provide medication name, dosage, specific times given each day, and reason for taking.
  • Please remember that this is a campus dining hall setting. Food cannot be prepared to order. The facilities may not have a kosher kitchen. Please check all restrictions that apply:
  • Please type your full name to e-sign the statement above.
  • Insurance Information

  • Emergency Release

  • Please type parent/guardian full name to e-sign the statement above:
  • Please check which of the following medication you ALLOW the staff to dispense to your child. If a box is not checked, the staff WILL NOT dispense that particular medication.
  • Please type full name to e-sign the selections above.

Thank you! If you have any questions, please contact Daniela Gonzalez-Jatar at 617-585-5462.